Access is a single federally qualified health center (FQHC), comprised of 51 individual sites. The Access service area spans from downtown Chicago to large portions of the city’s south and west sides and suburban DuPage County. Their total service area encompasses 1,700 square miles. Although Access is a single health center, Access claims that its annual patient volume (around 217,000 individuals for the current year) is the most for any health center in the country. Access’s primary care visit volume (600,000 visits), employee base (800 individuals: 230 board certified and board eligible physicians and midlevel providers, 300 RNs, licensed clinical social workers, medical assistants, case managers and outreach workers) also stand out as exceptional among FQHCs.
Figure 1 shows how the Sinai Family Health Centers span across several regions of the Chicago metropolitan area.
Figure 1: Access Community Health Network Service Area
Access began as Sinai Family Health Centers, an entity that brought together a small group of ambulatory clinics established and operated by Mount Sinai Hospital on Chicago’s west side. These centers were originally designated federally qualified health center (FQHC) “look-alikes.” In the early 1990’s Sinai Family Health Centers won a small grant and used it to establish compliance with Section 330 requirements, thereby making it eligible for designation as an FQHC look-alike. Sinai Family Health Centers’ senior leadership team coalesced in 1994 and the organization’s first CEO stayed with the network until 2000.
In 2003, Sinai Family Health Centers was formally spun off from Sinai Health System and took on the name Access Community Health Network. Since then, Access has acquired many health centers across Chicago and its suburbs. These sites span several regions across the Chicago metropolitan area as shown in Figure 1 above. Like other health centers, Access serves a disproportionate number of racial and ethnic minorities (94 percent of their patients in a given year), individuals on Medicaid (nearly half of all patients) and the uninsured (over 20 percent of patients). Overall, Access estimates that it serves approximately 10 percent of all uninsured individuals in the Chicago area.
Access differs from many other CHCs taking part in this study because it is a single federally qualified health center, not a health center controlled network (HCCN), composed of multiple FQHCs. Access resembles an HCCN in that it has many sites, serving many communities. In many cases, health centers have joined Access after having been an independent FQHC. Access is also different in its historical relationship with Sinai Health System’s hospital and it’s reliance on the hospital to support its IT function for several years. While there have been some benefits to working with Sinai, as the health center has expanded to areas well beyond the service range for Sinai, its relationship with Sinai on IT issues in particular has become less important and, the need to establish a their own suite of IT applications and hosting capabilities has become apparent.
Access provides a variety of services geared toward individual and family care. Most Access sites offer standard primary care services as well as disease management, outreach and health education. Access sees specialty care as a significant gap for many underserved patients and is seeking to address the problem by expanding capacity in various specialties. Some Access centers offer specialty care such as dental care, obstetrics and gynecology, dermatology, HIV care, psychiatry and nephrology. Access has created one clinic solely devoted to specialty care and maintains strong ties with local hospitals to ensure that their patients can obtain access to necessary providers. Access works with state social service agencies to screen and enroll patients in Medicaid and the state’s SCHIP program, “All Kids.” Many Access sites include enrollment specialists expressly for this outreach function.